Tuberculosis (TB) is an enormous global public health problem and has emerged as a public health emergency in the independent country of Georgia due to high rates of drug-resistant TB. Georgia has been designated as one of 27 high burden MDR-TB countries by the World Health Organization. In 2013, 11.2% of newly diagnosed TB cases and 38.1% of retreatment cases in Georgia had MDR-TB. Important progress has been made over the past decade in developing the capacity, where none existed initially, to carry out internationally recognized TB-related research in Georgia. A critical mass f MD and PhD-level investigators is now emerging in Georgia. These past efforts provide a foundation for us to build upon for our renewal application entitled, Emory-Georgia TB Research Training Program (EGTB-RTP). This application represents a collaboration between Emory University and the two key public health institutions in Georgia involved in TB treatment and control, the National Center for Tuberculosis and Lung Diseases (NCTLD) and the National Center for Disease Control and Public Health (NCDC). Key goals of this application include: to continue to enhance the capacity at the NCTLD and NCDC to carry out implementation science research and tackle challenges imposed by recent health care reform in Georgia; to build upon achievements made in the past grant cycle and leverage new opportunities for translational research given enhanced laboratory infrastructure at both the NCTLD and NCDC; to build capacity for research at the intersection of TB and non-communicable diseases (NCDs) which are emerging pubic health problems in Georgia; and expand laboratory, epidemiology and clinical/translational research on MDR- and XDR-TB. This application is focused on supporting expansion of in- country research and research training opportunities.
The specific aims of this renewal application include: 1) Continue to build human capacity to conduct high quality TB-related research in Georgia by Georgian investigators by providing long, medium and short-term research training and research opportunities to candidates with outstanding potential. This includes providing opportunities for research training in relevant laboratory, clinical, translational, epidemiologic, implementation science and behavioral/social science related research; 2) Enhance capacity for in-country research training by providing mentorship and leadership training for former Fogarty trainees who go on to serve as in-country mentors (paired with a U.S.-based mentor) for new trainees; 3) Focus research and research training activities on enhancing capacity to conduct research on drug resistant TB and strengthen the public health infrastructure for control of MDR- and XDR-TB; 4) Expand the focus of the EGTB-RTP to include research and research training at the intersection of TB and NCDs and risk factors for NCDs (TB-diabetes, TB-smoking, TB-mental health and TB-nutrition). Given the convergence of infectious diseases with NCDs there is an urgent need to have multidisciplinary collaborations and integrated strategies that incorporate both TB and NCDs.

Public Health Relevance

Tuberculosis (TB) is an enormous global public health problem and has emerged as a public health emergency in the independent country of Georgia due to high rates of drug-resistant TB. The goal of this application entitled, 'Emory-Georgia TB Research Training Program (EGTB-RTP)', is to enhance TB-related research capacity in Georgia through research training of young Georgian investigators with great potential. Such efforts should result in building sustainable capacity to carry out internationally recognized TB-related research in Georgia and enhance the public health infrastructure for TB control in Georgia.